Kognitive mål er også omtalt i Dunne og McLoughlin (23) (se avsnitt 3) Parametre mm).
Kognitive funksjoner (N=11) Førsteforfatter
og årstall Tittel og Sammendrag Quiles (42)
2013 Objective memory impairment and memory complaints in subjects treated with electrocon-vulsive therapy: Selective literature review.
Objectives: Electroconvulsive treatment (ECT) is an efficient treatment of depression, mania or acute episode of schizophrenia. However, ECT can lead to several side effects, particularly regard-ing cognitive functionregard-ing. Neuropsychological tests show that memory impairment is the most com-mon cognitive disturbance. Memory impairments are also self-reported by 29 % to 55 % of patients treated with ECT. The subjective perception of memory impairment belongs to the field of metacog-nition (or, in this case, metamemory). Metacogmetacog-nition is indeed defined as monitoring and control of its own cognitive processes, and can be evaluated during or after cognitive task (on line or off line).
The subjective perception of memory impairment after ECT treatment has been scarcely explored in
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the literature. The aims of this review of the literature are to describe the " objectives" characteris-tics of memory impairment, the " subjective" characterischaracteris-tics of memory complaints observed after treatment with ECT, and the relationships that exist between objective and subjective memory im-pairment. Methods: This review is based on a selection of articles identified using PubMed. Three exhaustive literature searches of Medline databases between years 1970 and 2012 were per-formed. The first search used the words " Electroconvulsive therapy" and " Anterograde Memory Loss" from the Medical Subject Headings or MESH (41 articles). The second search used the MESH words " Electroconvulsive therapy" and " Retrograde Amnesia" (103 articles). The third search used the MESH words " Electroconvulsive therapy" and the words " Subjective Memory" not listed in the MESH (29 articles). Titles and abstracts of literature review or meta-analysis in English and French were carefully screened. Regarding " objective" memory impairment, only studies com-paring neuropsychological tests assessing memory conducted before and after treatment with cura-tive ECT were selected. Regarding " subjeccura-tive" memory impairment, only studies assessing memory complaints were selected. A selection of 29 relevant articles was carried out. Results: The only " objective" long-term cognitive impairment observed after treatment with ECT is retrograde autobiographical memory impairment. Anterograde memory performances (learning, episodic and visuospatial memory) are disrupted in the short-term period following ECT, but no longer several months later. Three self-administered questionnaires assessing " subjective" memory complaints are available: Cognitive Failure Questionnaire or CFQ (assessing perceived learning, attention and memory functions), Squire Subjective Memory Questionnaire or SSMQ (evaluating perceived spe-cific memory functions) and Global Self-Evaluation-Memory or GSE-My (evaluating perceived glob-al memory impairment). After ECT treatment, improvement in the CFQ scores and SSMQ (less memory complaints) is observed. However, scores at GSE-My are significantly lower after treat-ment, suggesting that subjects rate their global memory functioning as impaired by ECT. " Subjec-tive" memory complaints are correlated with " objecSubjec-tive" memory impairment, when complaints are globally assessed using the GSE-My. Conclusion: The fact that there is no long-term cognitive im-pairment after treatment with ECT is an important information that must be shared within the healthcare team and the patients in order to improve adhesion to ECT. Few studies have investi-gated subjective complaints, and no study has evaluated metacognitive skills during the cognitive task. It might be of interest to explore subjective memory changes after ECT by using on line meta-cognitive skills evaluation.
Verwijk (43)
2012 Neurocognitive effects after brief pulse and ultrabrief pulse unilateral electroconvulsive therapy for major depression: a review
BACKGROUND: Neurocognitive functioning is well known to be affected after ECT. However quan-tified data about the severity of the cognitive impairment after ultrabrief pulse and brief pulse ECT are limited, which makes it hard to judge its clinical relevance.
METHODS: To review all prospective studies using right unilateral (ultra) brief pulse index electro-convulsive therapy published up until February 2011 which used at least one instrument for cogni-tive assessment before and after ECT. The severity and persistence of neurocognicogni-tive side effects immediately (one to seven days post ECT), between one and six months and after six months post ECT were assessed by calculating effect sizes using Cohen's d.
RESULTS: Ten studies fulfilled the inclusion criteria and provided detailed information to compute effect sizes. The results indicate loss of autobiographical memory and impairment of verbal fluency, anterograde verbal and non-verbal memory immediately after brief pulse RUL ECT. To a lesser extent impairment of working memory and reduced speed of processing is found. Autobiographical memory is the only domain still being impaired between one and six months post ECT, but im-proved in this period. Verbal fluency normalized to baseline performance between one and six months post ECT whereas anterograde verbal and non-verbal memory normalized or even im-proved. Speed of processing improved within six months after ECT. Long-term data on these cogni-tive domains were not available. Based on two of the ten included studies the results suggest that ultrabrief pulse RUL ECT causes less decline in autobiographical and anterograde memory after ECT than brief pulse RUL ECT.
LIMITATIONS: This review may be limited because of the small number of included studies and due to unreliable effect sizes. Furthermore, few data were available for non-memory domains and cogni-tive functioning after six months.
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CONCLUSIONS: Loss of autobiographical memory is still present between one and six months af-ter unilaaf-teral brief pulse ECT. Ultrabrief pulse RUL ECT shows less decline in autobiographical memory. Other neurocognitive impairments after brief pulse RUL ECT seem to be transient.
McClintock (44) 2011
The effects of electroconvulsive therapy on neurocognitive function in elderly adults Electroconvulsive therapy (ECT) is a commonly used treatment for elderly adults with severe major depressive disorder. Technical advances have maximized the efficacy of ECT while reducing side effects, particularly cognitive adverse effects. Careful monitoring of depressive symptomatology and neurocognitive functions using measurement-based care methods are recommended during the treatment course to systematically guide the administration of ECT. In this systematic review, the authors describe the advances in ECT administration that have improved its efficacy and summa-rize the available information regarding the associated adverse cognitive effects in elderly adults Semkovska
(45) 2011
Unilateral brief-pulse electroconvulsive therapy and cognition: effects of electrode place-ment, stimulus dosage and time
To clarify advantages of unilateral electrode placement as an optimisation technique for electrocon-vulsive therapy (ECT) for depression, aims were to meta-analyse unilateral ECT effects on cognitive performance relative to: (1) bitemporal electrode placement, (2) electrical dosage, and (3) time in-terval between final treatment and cognitive reassessment. Relevant electronic databases were systematically searched through May 2009, using the terms: "electroconvulsive therapy" and ["cog-niti*", "neuropsycholog*", "memory", "attention", "executive", "spatial", or "intellectual"]. Inclusion criteria were: independent study of depressed patients receiving unilateral or bitemporal brief-pulse ECT; within-subjects design; use of objective cognitive assessments; available mean electrical dos-age for unilateral samples. Standardized pre-post ECT weighted effect sizes were computed and pooled within 16 cognitive domains by a mixed-effects model. Thirty-nine studies (1415 patients) were meta-analysed. Up to three days after final treatment, unilateral ECT was associated with sig-nificantly smaller decreases in global cognition, delayed verbal memory retrieval, and ical memory, compared to bitemporal ECT. Significant publication bias was found for autobiograph-ical memory, favouring reporting of larger percentage loss. Higher unilateral ECT electrautobiograph-ical dosage predicted larger decreases in verbal learning, delayed verbal memory retrieval, visual recognition, and semantic memory retrieval. When retested more than three days after completing ECT, no sig-nificant differences remained between the two electrode placements; for unilateral ECT, electrical dosage no longer predicted cognitive performance whereas increasing interval between final treat-ment and retesting predicted growing improvetreat-ment in some variables. This interval is a more useful long-term predictor of cognitive function than electrode placement or electrical dosage following unilateral ECT
Semkovska (46) 2010
Objective cognitive performance associated with electroconvulsive therapy for depression:
a systematic review and meta-analysis
BACKGROUND: Electroconvulsive therapy (ECT) is the most acutely effective treatment for de-pression, but is limited by cognitive side effects. However, research on their persistence, severity, and pattern is inconsistent. We aimed to quantify ECT-associated cognitive changes, specify their pattern, and determine progression
METHODS: MEDLINE, EMBASE, PsycArticles, PsychINFO, PsychLIT, and reference lists were systematically searched through January 2009. We included all independent, within-subjects design studies of depressed patients receiving ECT where cognition was assessed using standardized tests. Main outcome was change in performance after ECT relative to pretreatment scores with re-spect to delay between finishing ECT and cognitive testing. We explored potential moderators' in-fluence, e.g., electrode placement, stimulus waveform
RESULTS: Twenty-four cognitive variables (84 studies, 2981 patients) were meta-analyzed. No standardized retrograde amnesia tests were identified. Significant decreases in cognitive performance were observed 0 to 3 days after ECT in 72% of variables: effect sizes (ES) ranging from -1.10 (95% confidence interval [CI], -1.53 to -.67) to -.21 (95% CI, -.40 to .01). Four to 15 days post-ECT, all but one CI included zero or showed positive ES. No negative ES were observed after 15 days, with 57% of variables showing positive ES, ranging from .35 (95% CI, .07-.63) to .75 (95% CI, .43-1.08). Moderators did not influence cognitive outcomes after 3 days post-ECT
CONCLUSIONS: Cognitive abnormalities associated with ECT are mainly limited to the first 3 days posttreatment. Pretreatment functioning levels are subsequently recovered. After 15 days,
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cessing speed, working memory, anterograde memory, and some aspects of executive function improve beyond baseline levels
McLoughlin (47) 2010
Meta-analysis of the cognitive side-effects of electroconvulsive therapy
BACKGROUND: Electroconvulsive therapy (ECT) for depression may be limited by cognitive side-effects although their nature is unclear. We did a systematic review and meta-analysis to quantify ECT-associated cognitive dysfunctions, specify their configuration and determine how they progress over time.
METHODS: We searched MEDLINE, EMBASE, PsycARTICLES, PsychINFO, PsychLIT up to Jan-uary 2009. Eligible studies had within-subjects design, involving depressed patients receiving ECT and assessed with standardised cognitive tests. Main outcome was performance change after ECT relative to pre-treatment scores. We extracted delays between finishing ECT and cognitive testing.
RESULTS: Twenty-four cognitive variables from 84 studies (2981 patients) were meta-analysed.
Significant decreases in performance were observed 0-3 days post-ECT in 72% of variables, effect sizes (ES) range -110 (95% CI, -153 to -067) to -021 (95% CI, -040 to -001). Four to 15 days after ECT, all but one CI included zero or showed positive ES. No negative ES were observed after 15 days with 57% of variables showing a positive ES, range 035 (95% CI, 007 to 063) to 075 (95% CI, 043 to 108).
CONCLUSIONS: Cognitive abnormalities associated with ECT, and as detected by standardised tests, are mainly limited to the first three days post-treatment. Moderators (e.g. electrode placement and stimulus waveform) did not influence cognitive outcomes after three days post-ECT. Pre-treatment function was subsequently recovered. After two weeks, processing speed, working memory, anterograde memory and some aspects of executive function improved beyond baseline levels
Plakiotis (48)
2009 Bifrontal ECT: A systematic review and meta-analysis of efficacy and cognitive impact The aim of this paper is to review the literature regarding bifrontal electroconvulsive therapy (ECT) and provide recommendations for future research in this area. Original publications were retrieved using PubMeD, EMBASE, PsycINFO, and Google Scholar. A systematic review and meta-analysis of randomised clinical trials examining efficacy and/or cognitive effects of bifrontal ECT for the treatment of depression is the centrepiece of this paper. The literature regarding bifrontal ECT is limited, with small patient numbers and treatment variation across studies complicating result inter-pretation. However, our findings suggest that while bifrontal and bitemporal ECT may have similar efficacy, bifrontal ECT is associated with less cognitive impairment immediately after a treatment course. Bifrontal ECT may have greater efficacy than low-dose right unilateral ECT but less efficacy than high-dose right unilateral ECT. Conversely, bifrontal ECT may affect cognition more adversely than low-dose right unilateral ECT, but less so than high-dose right unilateral ECT. To further inves-tigate the likely favourable benefit to cognitive risk profile of bifrontal ECT, detailed cognitive testing should be undertaken as part of any future, large scale studies comparing the efficacy of adequate-ly-dosed bifrontal, bitemporal and right unilateral ECT.
Gardner (49)
2008 A review of the cognitive effects of electroconvulsive therapy in older adults
OBJECTIVE: To review studies that examined the impact of electroconvulsive therapy (ECT) on cognitive functioning in depressed older people
METHODS: Studies were systematically retrieved using PsychINFO and MEDLINE, with additional articles sourced from lists of references. Given our aged-care focus, study participants had a mini-mum mean age of 60 years, with no single participant younger than 50 years
RESULTS: Twenty-seven studies met our criteria. Apart from evidence of interictal slowing of infor-mation processing speed, there were mixed results with regard to the impact of ECT on other cogni-tive domains. Factors contributing to this variability in results include the lack of discrimination be-tween unilateral, bilateral, or mixed electrode placement; the inclusion of patients with dementia; the small sample sizes; and the use of tests insensitive to subtle cognitive changes
CONCLUSIONS: The effect of ECT in elderly recipients' cognition remains unclear, and further re-search with more critically selected methods is required. In the meantime, we recommend that clini-cians regularly administer brief focused cognitive tests before, during, and after treatment to monitor progress. [References: 67]
Fraser (50)
2008 The effect of electroconvulsive therapy on autobiographical memory: a systematic review OBJECTIVES: In the last 20 years, an increasing number of articles have been published about
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effects of electroconvulsive therapy (ECT) on memory. Here, we review autobiographical memory studies in particular because there have been conflicting reports about the extent and persistence of ECT effects and the period before treatment from which memories are most likely to be affected METHODS: Five psychological and medical databases (MEDLINE, PubMed, PsychINFO, Sci-enceDirect, and Web of Knowledge) were searched from 1980 to 2007, yielding 15 studies of ECT and autobiographical memory
RESULTS: Evidence suggests that autobiographical memory impairment does occur as a result of ECT. Objective measures found memory loss to be relatively short term (<6 months posttreatment), whereas subjective accounts reported amnesia to be more persistent (>6 months post-ECT). Elec-troconvulsive therapy predominantly affects memory of prior personal events that are near the treatment (within 6 months). Autobiographical memory loss is reduced by using brief pulse ECT rather than sine wave-unilateral positioning of electrodes rather than bilateral-and by titrating elec-trical current relative to the patient's own seizure threshold
CONCLUSIONS: Further research is required to determine memory loss associated with ECT, con-trolling for the direct effects of the depressive state. [References: 37]
Koopowitz (51)
2004 Review: at least one third of people report persistent memory loss after electroconvulsive therapy
What are patients' views on the treatment benefits of electroconvulsive therapy and to what extent is persistent loss of memory an adverse effect of this treatment?
METHODS: Design: Systematic review Data sources: MEDLINE, PsycINF0, Web of Science, and the Social Science Citation Index (search date 2001); hand searches of reference lists
Study selection and analysis: Studies were included if they reported on people's views on treatment with electroconvulsive therapy (ECT). Exclusions: reports of lay or professional opinions, studies in children or adolescents, or if not all people received treatment. Data were extracted for the propor-tion of people with "positive responses" to statements on ECT (a positive response was defined as an affirmative response to either of the following statements: "ECT is helpful" or "I would have ECT again"); the time between treatment and interview; the number of questions asked; the complexity of the interview, and the setting of interview and status of interviewer. Outcomes: Patients' views on electroconvulsive therapy, memory loss
MAIN RESULTS: Thirty five studies met inclusion criteria. Perceived benefit: there was substantial heterogeneity among studies (see Notes). The studies reported that between 20% and 90% of peo-ple found ECT helpful. However, the reported efficacy was related to methodological features of the included studies. People were more likely to report positive views on ECT if they were interviewed soon after treatment. Conversely, people who were not interviewed by their treating doctor or who were interviewed at home were less likely to report positive views. Safety: among 7 studies that reported on memory loss, the rate of persistent or permanent memory loss after ECT ranged from 29% to 55%
CONCLUSIONS: Studies examining perceived benefits of ECT among patients may be biased by their methods. However, there appears to be consistent evidence that memory loss is common fol-lowing ECT.
NOTES: The systematic review did not exclude studies based on their design or quality of their methods. It is not surprising, therefore, to find heterogeneity of results. However the study goes further in examining sources of heterogeneity, and importantly it demonstrates consistent evidence of harm (memory loss).
Khan (52) 1993
Can ECT-induced cognitive effects be altered pharmacologically?
1. A systematic review of the literature revealed twelve clinical trials that evaluated nine different drugs, and used three different conceptual models to prevent, restore or treat ECT-induced cogni-tive deficits. 2. This review indicated inconclusive results regarding clinical utility of any of the drugs.
3. Major factors discussed include the complexities involved in the evaluation of ECT-induced cog-nitive deficits, and the techniques of evaluating changes in cogcog-nitive functions. 4. Our conclusion is that future research should emphasize understanding the neural mechanisms related to ECT-induced cognitive deficits. We suggest several areas for future exploration. [References: 54]
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7) Tilbakefall, forebygging, vedlikeholds ECT (M-ECT) (7)